Temple Street Job Centre Covid-19 Vaccination Clinic - Updated

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NHS logo with BNSSG underneath plus Bristol City Council (BCC) Logo [do not see how to submit these]

Organisation/s: What organisation/s were involved?

BNSSG C-19 Vax programme, BCC Community Development Team, Sirona care & health, community pharmacy, and a variety of voluntary organisations.

The challenge: What was the issue you were trying to solve? Include which Inclusion Health Group the initiative focused on and its level i.e. community/locality/system

Despite a strong focus on vaccination outreach, in February 2022 (12 months into the Covid-19 Vaccination Programme) our data and feedback from Inclusion Health colleagues working in Inner City Bristol told us that some people remained less likely to have their primary Covid-19 vaccinations. This included people experiencing homelessness, people with insecure immigration status and sex workers. Colleagues reported that these groups have historic challenges in accessing all health and wellbeing services, not just Covid-19 vaccinations.

We wanted to build trust and resilience with these groups by removing access barriers to Covid-19 vaccination and saw an opportunity work with system partners to provide underserved people with integrated services alongside a vaccination offer - making every contact count. Also, we recognise how vital it is to bring a wider determinants lens to tackling inequalities.

7) The approach/solution: What did you do? What help did you receive? How did you go about delivery?

As an extension of our Covid-19 vaccination outreach approach of ‘going where people are’, we wanted to establish a regular, weekly vaccination clinic in a central-Bristol space that was trusted, accessible and felt safe for Inclusion Health Groups. In partnership with BCC’s Community Development Team, we identified the Temple Street Job Centre in central Bristol as an ideal site to support people with their unmet needs. The clinic was supported by two of BCC’s Inclusive Community Facilitators and Community Champions who were known to and familiar with the people we hoped to target, alongside our community service provider, Sirona care & health, community pharmacy and vaccination programme staff.

Effective partnership working through collaborating with these colleagues and the voluntary sector, we created a warm, welcoming space within the Job Centre that provided tea and biscuits alongside Covid-19 vaccination and other services. This included supporting people who experience poor health and outcomes practically with health literacy, mental health advice, first aid treatment, sign-posting and housing support. Importantly, the support of BCC’s Community Facilitators and Community Champions meant we were able to do this in people’s spoken language.

8) Insights and impacts: What evidence proves it worked? What difference it makes to the Inclusion Health Groups? How did this improve experiences, access and inclusion? How did this improve their health and help address health inequalities?

Between May 2022 and March 2023, we had 2,480 conversations with people at the Temple Street Job Centre Vaccination Clinic; over 450 people went on to have Covid-19 vaccinations (a high proportion of which were primary doses); and over 70 had their flu vaccination. Many of these people were at high risk of a worse outcome from a Covid-19 infection.

The clinic had a consistently high attendance of around 80 people at each clinic, particularly among men, with many people returning for follow-up conversations. It opened up an opportunity to support people’s health and wellbeing, linking to community and NHS services through social prescribing.

Co-locating vaccination alongside other services in an accessible location meant we were able to reach people from inclusion groups who might otherwise have been missed. We supported people fleeing domestic violence, people who had been incarcerated, rough sleepers, sex workers, people with insecure immigration status and people from the LGBTQ+ community. Notably, we also supported extremely vulnerable people who intersected some of these Inclusion Groups.

Through the clinic we had success in supporting people with registration into Primary Care, especially rough sleepers. By treating minor wounds, we were able to avoid visits to A&A, reducing hospital admissions and associated costs by early intervention.

We were able to arrange for a Sudanese BCC Community Champion to support a Sudanese man who didn’t speak English. In Sudan there is no free health care and little State intervention, and he didn’t know how to engage with the NHS or manage his healthcare. We supported him to register with a GP and when he raised some issues around housing, the Community Champion was able to translate some documents, which he hadn’t understood.

We created an opportunity to gain people’s lived experiences through conducting a survey at the clinic to gain more in-depth insight into people from Inclusion Health Groups and their needs, and preferences. We had 276 responses, 177 people who took up offer of a Covid-19 vaccination, and 99 who declined. Two thirds of respondents were men. The survey captured that people attended from the most deprived areas in Bristol, also people who voices are marginalised and with a majority of respondents from Black and Asian heritage. Many of the people who attended highlighted how they have experienced racism, discrimination and exclusion in their capacity of being regarded as vulnerable or disadvantaged.

9) What people said: Any quotes or feedback from service users, staff, management or decision makers

BCC’s Inclusive Community Facilitator, said: “This clinic has shown what can be done with a tea urn, some biscuits and determination to make sure everyone knows why it’s important to get vaccinated.”

Feedback from the survey cited the following key reasons for taking up the offer of a Covid-19 vaccination at the Temple Street Job Centre Clinic:

• the opportunistic convenience of vaccination availability,
• as well as encouragement from BCC’s Community Champions, and
• realisation it was important to have all their doses.

Some things people told us in the survey:

“Was at Temple Street and was spoken to by [named BCC Community Champion] who explained that I could get 4th jab. So decided to get it done today as had missed an appointment at the doctors.”

“Hadn't realised that I needed a 3rd jab, [named BCC Community Champion] explained why it was important. Decided to get it done today.”

“Was at the job centre so was easy to get the jab.”

“Spoke with [named BCC Community Champion] at Temple Street who explained more about the vaccine and encouraged me to get done today.”

10) Tips for success: Approaches or links that make a difference or lessons learned.

To reach Inclusion Health Groups it is particularly important to co-locate vaccination services in convenient, accessible locations where people already are.

The support of trusted, relevant organisations was crucial. In particular, the engagement work before and during clinics by BCC’s Community Champions made a huge difference to attendance and vaccination uptake at the clinic.

The Vaccination Clinics were able to do so much more than just offer Covid-19 vaccinations. They allowed early intervention and prevention for people experiencing multiple inequalities, not just health. In particularly the opportunity to engage with people at the intersection of multiple Inclusion Health Groups was clear.

Covid-19 vaccination uptake is low within Inclusion Health Groups so the good vaccination rates within this clinic directly reduced the risk of Covid outbreaks among vulnerable people, alongside supporting their overall health literacy.

It is important to provide a consistent offer with the same staff and regular clinics over a period of time. Many people made repeat visits to the clinic and trust of recognisable faces built over time.

All of these components are important to the success of this clinic model. In June 2023, BCC’s community engagement team were focused on other initiatives and the clinic was not as well-attended and vaccination numbers were a lot lower.

11) What next: What are you doing next?

This approach needs to be more sustainable, rather than a temporary solution to Covid-19 vaccination uptake.

We are taking a paper to the Bristol’s Health and Wellbeing Board, highlighting the success of co-locating vaccination and health services in accessible, central locations to reach Inclusion Health Groups who might otherwise be missed. If the Board supports this approach, we hope to gain funding from all our system partners to run a similar clinic in Autumn alongside the seasonal Covid-19 offer.

Following this, we plan to submit a proposal to BNSSG’s Integrated Care Board to raise awareness and encourage their support and funding for this this approach for the Autumn seasonal Covid-19 and flu vaccination programme.

In the meantime, we continue to collaborate with system and community partners across all our community vaccination clinics. Most recently, we have invited voluntary and community organisations to attend any of our community vaccination clinics, which are located in underserved areas to pilot this approach for the autumn seasonal flu and Covid-19 vaccination campaign.